Cutting the Ribbon: The EMSB Digital Research Library

Around here, we’re big believers in evidence-based medicine. Yes, it has flaws, and yes, it can be challenging to properly interpret and apply, but like they say about life, it’s the only game in town.

And sure, you can let other people read the research and tell you how to treat patients. And since by and large, we work under protocols written by physicians, that is inevitably what we do. Yet everybody understands that within that framework, there’s still a great deal of leeway — there are decisions that need to be made every day, and you cannot make them intelligently without understanding what you’re doing and why. If you’re not basing your decisions on science, you’re basing them on personal prejudice, anecdotal experience from your career (which is inevitably weaker than you think), and the similar poor compasses of colleagues and coworkers.

No good. We should all strive to have reasons for the things we do, because that lets us modify our actions, omit them, prioritize them, and otherwise tailor our care to the unique situation and unique patient in front of us.

Unfortunately, directly engaging with peer-reviewed medical research is challenging. Searching through it is an acquired skill, reading it takes practice, and in many cases, we simply don’t have access to published full-text articles unless we’re affiliated with a university. The result is that many prehospital clinicians who want to practice intelligent, evidence-based medicine aren’t able to do so, at least not easily.

This is an index of medical papers on topics relevant to EMS, ranging from spineboards to sepsis; it’s easily searchable, and can be organized or filtered by the user according to whatever characteristics are desired. Rather than a raw data-dump from all the world’s journals, it’s hand-curated by our volunteer editors, who read each piece from cover to cover, summarize the contents, file them and rank them by quality and relevance. The result? If you want to discover what we know so far on a specific topic, instead of facing a blank, unending sea of medical research, you’ll have a structured library of material organized for your convenience.

When you find the research you’re looking for, what then? If you lack academic or institutional journal access, we’re here for you. Simply email us a request for the papers you need, and we’ll provide them to you privately. We wish it were possible to simply post them online for the world to access, but that would violate copyright law in an egregious way. (When specific papers have been made freely availably by their publisher, we do link them directly in the index.)

How effective is aspirin for chest pain? What’s the chance a patient with head injury has a C-spine fracture? Does it matter if your stroke patient walks to the stretcher? Is supplemental oxygen important during sepsis? What’s the number-needed-to-treat for endotracheal intubation? These are the kinds of questions that are hard to answer now, but will be easy to answer using our library — at least, once it’s grown enough to address those topics. There are tens of thousands of papers out there, and one day we’d like to list them all, but we’re starting with a seed of about a hundred — a very well-developed body of spinal immobilization literature (probably over 90% of the quality research on the subject), plus a scattering of interesting material in other topics. Everything starts somewhere, and it’ll continue to expand.

The Library is managed at this time by my colleague Vince DiGiulio, Head Librarian and Master of Evidence-Based Codices. I help him out, along with a team of associate librarians. In any case, general library-related queries, research questions, or paper requests can all be submitted to librarian[at]emsbasics.com. Please remember that we’re all volunteers over here, so give us a little while to reply. And if you’re willing to contribute some time to help curate the database, let us know — we need help!

Folks, this will be a constantly-growing project. We’ll be striving to continually add more material, both new and old, and updates will be announced on the library page (as well as the Facebook group). The entire system is still in the early stages, so bear with us through any changes or hiccoughs. And remember: if you’re not thinking about how you know what you know, you’re not a clinician, you’re a monkey. And if the way you know what you know isn’t through science and reason, you’re just a witch doctor.